The hindrances to perform the COVID-19 vaccination in Brazil

Figures & data

Table 1. Characterization of the approved COVID-19 vaccines worldwide.^9,14–22.

Vaccine	Phase III trial	Developer	Doses needed	Time from the first dose to the second one	Efficacy (%)	Immune mechanism	Main adverse effects	Storage (^oC)	Approved in	Emergency use	Cost of the dose (USD $)
BNT162b2	Yes	Pfizer/BioNTech^TM	2	3 weeks	91	mRNA	Pain, swelling and redness in the injection site, fatigue, headache, fever, and chills	–25 to – 15°C	Brazil, Bahrain, New Zealand, Saudi Arabia, and Switzerland	Argentina, Australia, Botswana, Brunei, Canada, Chile, Colombia, Costa Rica, Ecuador, European Union, Greenland, Guatemala, Hong Kong, Iceland, Iraq, Israel, Japan, Jordan, Kuwait, Lebanon, Liechtenstein, Malaysia, Maldives, Mexico, Moldova, Monaco, Mongolia, Norway, North Macedonia, Oman, Panama, Peru, Philippines, Qatar, Serbia, Singapore, South Africa, South Korea, Tunisia, Turkey, Ukraine, United Arab Emirates, United Kingdom, United States, and Uruguay	14.7 to 19.5
mRNA-1273	Yes	Moderna^TM	2	4 weeks	94.1	mRNA	Pain, erythema, induration, tenderness, headache, fatigue, myalgia, and chills	–20°C	Switzerland	Canada, European Union, Greenland, Guatemala, Honduras, Iceland, Israel, Kuwait, Mongolia, Norway, Qatar, Singapore, United Kingdom, United States, and Vietnam	25 to 37
Sputnik V	Yes	Gamaleya Research Institute	2	3 weeks	91.6	Viral Vector	Flu-like illness, injection site reactions, headache, and asthenia	2 to 8°C	None	Russia, Albania, Algeria, Angola, Antigua and Barbuda, Argentina, Armenia, Azerbaijan, Bahrain, Bangladesh, Belarus, Bolivia, Bosnian Serb Republic, Cameroon, Congo Republic, Djibouti, Egypt, Honduras, Gabon, Ghana, Guatemala, Guinea, Guyana, Hungary, India, Iran, Iraq, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Laos, Lebanon, Mali, Mauritius, Mexico, Moldova, Mongolia, Montenegro, Morocco, Myanmar, Namibia, Nepal, Nicaragua, North Macedonia, Pakistan, Palestinian Authority, Panama, Paraguay, Philippines, San Marino, Slovakia, Sri Lanka, St. Vincent and the Grenadines, Serbia, Seychelles, Syria, Tunisia, Turkey, Turkmenistan, United Arab Emirates, Uzbekistan, Venezuela, Vietnam, and Zimbabwe	<10
AZD1222	Yes	AstraZeneca/Oxford^TM	2	4 months (recommended)	70.4	Viral Vector	Fatigue, headache, reactions at the injection site, fever, nausea, vomiting, and dizziness	2to 8°C	Brazil	Algeria, Argentina, Australia, Bahamas, Bahrain, Bangladesh, Barbados, Bhutan, Botswana, Brunei, Canada, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Egypt, El Salvador, Ethiopia, European Union, Fiji, Georgia, Ghana, Greenland, Guatemala, Honduras, Hungary, Iceland, India, Indonesia, Iran, Iraq, Jamaica, Kenya, Kuwait, Liechtenstein, Malaysia, Maldives, Mexico, Moldova, Mongolia, Morocco, Namibia, Nepal, Nigeria, North Macedonia, Norway, Pakistan, Papua Guinea, Peru, Philippines, Saudi Arabia, Seychelles, Sri Lanka, South Africa, South Korea, Sudan, Taiwan, Thailand, Ukraine, United Kingdom, Vietnam, and Zambia. Emergency use validation from the World Health Organization. Endorsed by the Africa Regulatory Taskforce. Recommended for emergency use by the Caribbean Regulatory System	2 to 10
Ad5-nCov	No	CanSinoBio^TM	1	NA	65.4	Viral Vector	Pain at injection site, fever, fatigue, nausea, and vomiting	2 to 8°C	China	Chile, Hungary, Mexico, and Pakistan	<4
Ad26.COV2.S	Yes	Johnson/Janssen^TM	1	NA	69	Viral Vector	Pain in the injection site, headache, fatigue, myalgia, and fever	2 to 8°C	Denmark	Bahrain, Brazil, Canada, Colombia, European Union, Greenland, Iceland, Liechtenstein, Norway, Philippines, South Africa, South Korea, Switzerland, Thailand, United States, and Zambia. Emergency use validation from the World Health Organization. Endorsed by the Africa Regulatory Taskforce	2.80 to 9
EpiVacCorona	No	Bektop^TM	2	3 weeks	NA	Protein Based	NA	2 to 8°C	Turkmenistan	Russia	NA
ZF2001	No	ZFSW/Institute of Medical Biology	3	4 weeks	NA	Protein Based	Pain at injection site, redness, itch, cough, fever, and headache	2 to 8°C	None	China	NA
Unnamed	No	Sinopharm^TM	NA	NA	72.5	Inactive or attenuated virus	Not informed	2 to 8°C	China	United Arab Emirates	30 to 72.5
BBIBP-CorV	No	Sinopharm^TM	2	3 weeks	78.1	Inactive or attenuated virus	Pain at injection site, fever, fatigue, nausea, and vomiting	2 to 8°C	Bahrain, China, and United Arab Emirates.	Argentina, Bangladesh NEW, Brunei, Cambodia, Egypt, Gabon, Guyana, Hungary, Indonesia, Iran, Iraq, Jordan, Lebanon, Maldives, Morocco, Namibia, Nepal, North Macedonia, Pakistan, Peru, Venezuela, and Zimbabwe. Emergency use validation from the World Health Organization	30 to 72.5
CoronaVac	No	Sinovac^TM	2	2 weeks	50.7 (Brazil)	Inactive or attenuated virus	Pain, swelling, redness, fatigue, diarrhea, fever, and headache	2 to 8°C	China	Azerbaijan, Brazil, Cambodia, Chile, Colombia, Ecuador, Egypt, Hong Kong, Indonesia, Laos, Malaysia, Mexico, Pakistan, Panama, Philippines, Thailand, Tunisia, Turkey, Ukraine, Uruguay, and Zimbabwe	30
Covaxin	No	Bharat Biotech^TM	2	4 weeks	78	Inactive or attenuated virus	Headache, fatigue, nausea, and vomiting	2 to 8°C	None	Botswana, Guatemala, Guyana, India, Iran, Mauritius, Mexico, Nepal, Nicaragua, Paraguay, Philippines, and Zimbabwe	2 to 3
QazCovid-in	No	RIBSP^TM	NA	NA	NA	Inactive or attenuated virus	NA	2 to 8°C	None	Kazakhstan	NA
CoviVac	No	Chumakov Center	2 or 3	2 weeks	NA	Inactive or attenuated virus	NA	2 to 8°C	None	Russia	NA

NA; Not available or it was not possible to identify the data.

Table 2. Descriptive analysis of the COVID-19, demographics data from Brazilian territory, gross domestic product (GDP) and intensive care units (ICUs) availability.^25–30.

States and the Federal District	COVID-19 cases	Deaths by COVID-19	Prevalence by 100,000 inhabitants	Mortality by 100,000 inhabitants	GDP (R$) x 10^3	Number of inhabitants	% Of the population from Brazil	Area (km^2)	Population density (persons per km^2)	ICUs bed by 10,000 habitants
Acre	80,177	1,608	9,091	182	13,751	881,935	0.4	164,123.74	5.37	1.60
Alagoas	182,969	4,462	5,482	133	49,456	3,337,357	1.6	27,843.30	119.86	1.60
Amapá	108,719	1,610	12,855	190	14,339	845,731	0.4	142,470.76	5.94	0.99
Amazonas	378,138	12,808	19,124	309	89,017	4,144,597	2.0	1,559,168.12	2.66	1.29
Bahia	948,753	19,739	6,379	133	258,649	14,873,064	7.1	564,722.61	26.34	1.85
Ceará	734,766	18,995	8,046	208	138,379	9,132,078	4.3	148,894.76	61.33	1.74
Federal district	390,805	8,275	12,961	274	235,497	3,015,268	1.4	5,760.78	523.41	4.33
Espírito Santo	456,999	19,151	11,372	253	109,227	4,018,650	1.9	46,074.44	87.22	3.63
Goiás	577,347	16,027	8,226	228	181,692	7,018,354	3.3	340,125.72	20.63	2.49
Maranhão	278,137	7,674	3,931	108	85,286	7,075,181	3.4	329,642.17	21.46	1.37
Mato Grosso	378,708	10,189	10,868	292	123,834	3,484,466	1.7	903,207.00	3.86	2.95
Mato Grosso do Sul	262,551	6,163	9,448	222	91,866	2,778,986	1.3	357,145.54	7.78	3.16
Minas Gerais	1,451,836	37,005	6,858	175	544,634	21,168,791	10.1	586,521.12	36.09	2.55
Paraná	1,012,015	24,330	8,851	213	401,662	11,433,957	4.1	199,305.24	57.37	2.59
Paraíba	307,542	7,178	7,654	179	59,089	4,018,127	1.9	56,467.24	71.16	1.86
Pará	494,328	13,828	5,746	161	138,068	8,602,865	5.4	1,245,759.31	6.91	1.41
Pernambuco	437,783	14,841	4,581	155	167,290	9,557,071	4.5	98,068.02	97.45	2.56
Piauí	255,372	5,469	7,802	167	41,406	3,273,227	1.6	251,616.82	13.01	1.76
Rio Grande do Norte	247,512	5,785	7,058	165	59,661	3,506,853	1.7	52,809.60	66.41	2.30
Rio Grande do Sul	1,026,998	26,550	9,027	233	408,645	11,377,239	5.4	281,707.15	40.39	2.32
Rio de Janeiro	809,971	47,699	4,691	276	640,186	17,264,943	8.2	43,750.42	394.62	3.73
Rondônia	220,719	5,457	12,419	307	39,451	1,777,225	0.8	237,765.23	7.47	2.56
Roraima	99,459	1,568	16,419	259	11,011	605,761	0.3	224,273.83	2.70	1.29
Santa Catarina	924,602	14,351	12,905	200	256,661	7,164,788	3.4	95,730.92	74.84	2.53
Sergipe	215,831	4,669	9,389	203	38,867	2,298,696	1.1	21,926.91	104.83	1.80
São Paulo	3,069,804	103,493	6,685	225	2,038,005	45,919,049	21.9	248,219.48	184.99	2.43
Tocantins	167,684	2,704	10,661	172	31,576	1,572,866	0.7	277,720.40	5.66	1.80

The Brazilian GDP for 2017 was used. The number of Brazilian inhabitants, % of the population in each state or the Federal District and population density were estimated in 2019.

Table 3. COVID-19 vaccination plan in Brazil and the number of COVID-19 vaccines applied according to vaccine type and first or second dose.^13,25,29.

States and the Federal District	Individuals aged ≥60 years old or institutionalized	Institutionalized disabled people	Indigenous living at indigenous lands	Health workers (34%)	Phase 1 – target population	Vaccines available	COVID-19 Vaccines applied
							Coronavac (Sinovac™) dose		AZD1222 (AstraZeneca/Oxford™) dose		BNT162b (Pfizer/BioNTech™) dose
							First	Second	First	Second	First	Second
Acre	244	0	12,815	6,343	19,402	298,320	57,296	41,872	49,981	2,652	1,187	2
Alagoas	1,246	10	7,946	32,594	41,796	1,185,350	280,668	224,271	209,422	15,187	1,417	4
Amapá	76	0	7,616	7,057	14,749	229,880	63,421	41,863	37,827	3,800	370	1
Amazonas	400	60	101,156	32,813	134,429	2,022,100	330,120	240,741	253,102	70,348	525	3
Bahia	9,788	285	27,201	142,087	179,361	5,683,440	1,362,603	1,019,904	1,108,944	80,291	35,470	59
Ceará	2,398	132	20,250	86,380	109,160	3,212,360	771,285	558,360	382,059	44,462	11,405	59
Federal district	648	178	95	49,629	50,550	1,064,240	255,140	224,702	207,797	28,179	4,737	9
Espírito Santo	2,970	210	2,793	42,273	48,246	1,566,100	473,905	259,443	288,776	27,054	8,864	19
Goiás	8,828	475	320	77,549	87,172	2,435,120	592,519	515,776	495,249	51,252	18,063	17
Maranhão	264	110	19,626	58,223	78,223	2,394,810	503,303	418,496	450,915	34,877	14,631	17
Mato Grosso	2,382	190	28,758	28,744	60,074	1,109,830	288,891	214,595	192,994	19,507	76,002	254
Minas Gerais	38,578	1,160	7,878	227,472	275,088	8,909,924	2,120,270	1,649,241	1,366,387	95,684	39,843	52
Mato Grosso do Sul	2,966	95	46,180	26,356	75,597	1,057,320	333,495	209,217	244,727	22,337	5,760	5
Paraná	12,224	482	10,816	102,959	126,481	4,491,120	1,117,981	971,689	880,613	67,493	33,036	35
Paraíba	1,212	120	10,432	42,925	54,689	1,548,360	467,137	674,024	281,482	25,769	2,694	2
Pará	962	10	23,184	58,334	82,490	2,687,220	518,706	411,405	393,164	45,098	19,412	7
Pernambuco	2,462	130	26,506	99,924	129,022	2,451,830	898,861	674,024	489,088	47,358	438	17
Piauí	460	10	21	28,651	29,142	1,159,860	277,124	217,406	208,211	13,399	5,419	20
Rio Grande do Norte	1,400	10	0	37,848	39,258	1,291,880	359,706	249,417	215,336	25,377	993	2
Rio Grande do Sul	9,510	380	14,348	138,523	162,761	5,481,310	1,578,788	1,043,126	1,086,688	78,743	9,883	39
Rio de Janeiro	10,892	783	381	220,495	232,551	8,133,939	1,810,293	1,256,903	1,216,248	87,456	54,944	118
Rondônia	140	0	7,784	15,595	23,519	527,758	138,831	88,951	63,560	6,829	2,383	7
Roraima	100	0	36,834	4,833	41,767	221,620	61,171	51,043	10,952	374	763	1
Santa Catarina	3,460	263	8,317	56,540	68,580	2,752,720	645,753	564,707	461,968	27,076	57	3
Sergipe	240	22	250	22,760	23,272	792,790	177,610	133,787	129,250	4,576	3,535	10
São Paulo	42,604	1,357	3,727	598,518	646,206	20,067,074	4,585,390	3,746,120	3,259,160	253,009	135,622	416
Tocantins	424	0	6,749	13,803	20,976	504,200	133,998	112,422	70,434	6,391	239,273	605
Total	156,878	6,472	431,983	2,259,227	2,854,560	83,280,475	20,204,265	15,813,505	14,054,334	1,105,835	726,726	1,783

COVID-19 vaccination plan in Brazil was published by the Health Ministry from Brazil.

Table 4. COVID-19 vaccine [Coronavac (Sinovac™), AZD1222 (AstraZeneca/Oxford™), and BNT162b (Pfizer/BioNTech™)] doses status in Brazil by states and Federal District.^13,29.

States and Federal District	COVID-19 vaccines available (A)	Vaccines by 1 M inhabitants	Vaccines adjusted by number of cases (B)	Difference between (B) and (A)	Vaccines adjusted by number of deaths (C)	Difference between (C) and (A)
Acre	298,320	338,256	425,570	127,250	299,936	1,616
Alagoas	280,668	84,099	971,178	690,510	832,286	551,618
Amapá	229,880	271,812	577,068	347,188	300,309	70,429
Amazonas	2,022,100	487,888	2,007,112	−14,988	2,389,045	366,945
Bahia	5,683,440	382,130	5,035,868	−647,572	3,681,867	−2,001,573
Ceará	3,212,360	351,767	3,900,051	687,691	3,543,091	330,731
Federal district	1,064,240	352,950	2,074,346	1,010,106	1,543,516	479,276
Espírito Santo	1,566,100	389,708	2,425,696	859,596	3,572,189	2,006,089
Goiás	2,435,120	346,965	3,064,489	629,369	2,989,477	554,357
Maranhão	2,394,810	338,480	1,476,318	−918,492	1,431,412	−963,398
Mato Grosso	1,109,830	318,508	2,010,137	900,307	1,900,529	790,699
Mato Grosso do Sul	1,057,320	380,470	1,393,589	336,269	1,149,569	92,249
Minas Gerais	8,909,924	420,899	7,706,173	−1,203,751	6,902,452	−2,007,472
Paraná	4,491,120	392,788	5,371,655	880,535	4,538,216	47,096
Paraíba	1,548,360	385,344	1,632,396	84,036	1,338,895	−209,465
Pará	2,687,220	312,363	2,623,834	−63,386	2,579,303	−107,917
Pernambuco	2,451,830	256,546	2,323,700	−128,130	2,768,256	316,426
Piauí	1,159,860	354,348	1,355,484	195,624	1,020,119	−139,741
Rio Grande do Norte	1,291,880	368,387	1,313,764	21,884	1,079,062	−212,818
Rio Grande do Sul	5,481,310	481,779	5,451,183	−30,127	4,952,307	−529,003
Rio de Janeiro	8,133,939	471,125	4,299,230	−3,834,709	8,897,178	763,239
Rondônia	527,758	296,956	1,171,550	643,792	1,017,881	490,123
Roraima	221,620	365,854	527,917	306,297	292,475	70,855
Santa Catarina	2,752,720	384,201	4,907,677	2,154,957	2,676,857	−75,863
Sergipe	792,790	344,887	1,145,605	352,815	870,897	78,107
São Paulo	20,067,074	437,010	16,294,155	−3,772,919	19,304,297	−762,777
Tocantins	504,200	320,561	890,047	385,847	504,371	171

1 M, one million. The number of number of Brazilian inhabitants, % of the population in each state or the Federal District and population density were estimated in 2019. (A) Vaccines available in each state and federal district; Vaccines by 1 M inhabitants were calculated using the following formula: (number of vaccines by inhabitants) * 1 M; (B) Vaccines adjusted by the number of COVID-19 cases were calculated using the following formula: (number of COVID-19 cases by state or Federal District by all COVID-19 cases) * total number of vaccine dosages; (C) Vaccines adjusted by number of deaths by COVID-19 was calculated using the following formula: (number of deaths by state or Federal District by all deaths by COVID-19) * total number of vaccine dosages.

Table 5. Number of vaccines and percentage of the population that received each COVID-19 vaccine in Brazil.^13,29.

Vaccines	Number of COVID-19 vaccines		Percentage of the population that received each COVID-19 vaccine
	First dose	Second Dose	First dose	Second Dose
Coronavac (Sinovac™)	20,204,265	15,813,505	9.61	7.52
AZD1222 (AstraZeneca/Oxford™)	14,054,334	1,105,835	6.69	0.53
BNT162b (Pfizer/BioNTech™)	726,726	1,783	0.35	<0.01
Total	34,985,325	16,921,123	16.64	8.04

Figure 1. Percentage of population vaccinated according the first and second doses by states and Federal District.

Figure 2. Spearman correlation matrix between the number of COVID-19 vaccines by Brazilian inhabitants, number of COVID-19 vaccines per 1 M of inhabitants, number of COVID-19 vaccines adjusted by COVID-19 cases and deaths by COVID-19, number and percentage of Brazilian population vaccinated with the first and second doses with number of individuals with COVID-19, number of deaths by COVID-19, incidence by 100,000 inhabitants, mortality by 100,000 inhabitants, gross domestic product (GDP), the number of Brazilian inhabitants by states and Federal District, % of the population and populational density and the number of intensive care units (ICUs) beds in Brazil. The calculation of number of vaccines per 1 M inhabitants was done based on the following formula: (number of vaccines by inhabitants) * 1 M. The number of vaccines adjusted by number of COVID-19 cases was calculated using the following formula: (number of COVID-19 cases by state or Federal District by all COVID-19 cases) * total number of vaccine doses. The number of vaccines adjusted by number of deaths by COVID-19 was calculated using the following formula: (number of deaths by state or Federal District by all deaths by COVID-19) * total number of vaccine doses. The percentage of vaccinated population was calculated using the following formula: (number of vaccine doses by number of individuals in each state and Federal District) * 100. In the figure it was not shown the results of correlations for population density, ICUs beds and vaccines per 1 M of inhabitants because the correlation coefficient was low. It was considered the following categorization: (very high positive/negative correlation) 0.9 to 1.0; (high positive/negative correlation) 0.7 to 0.9; (moderate positive/negative correlation) 0.5 to 0.7; (low positive/negative correlation) 0.30 to 0.50; (negligible correlation) 0.00 to 0.30.

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